Assessment of childhood personality, traits and disorders: validation of a q-sort procedure

Introduction: The debate on childhood personality disorders still rages, despite a growing number of studies confirming that it is possible to evaluate childhood personality from a developmental perspective (Caspi et al. 2005, Widiger et al. 2009, McAdams & Olson 2010). Certain authors have inquired whether it is appropriate to evaluate personality in childhood, given the developmental features of mental functioning, but others, with the support of empirical and clinical data, confirmed the early structuring of PDs and the need for early intervention and prevention. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2; Lingiardi and McWilliams 2017) states that young children do have personalities and traits that may persist over time, and it underlines the importance of assessment even in childhood. The controversy over the existence of personality disorders in childhood has continued due to the limitations of studies in this research area and to the reluctance to apply adult personality diagnoses to children. The aims of this work are: to develop a Q-Sort assessment procedure for the evaluation of children personality and to give a contribution on the debate of childhood personality (Fortunato & Speranza, in press). Methods: From a literature review we derived seven Emerging Personality Patterns and four Personality Organizations. Through the four Mental Functions defined by the PDM-2 (cognitive and affective processes, identity and relationships, defense and coping, Self-awareness and self-direction) we described the characteristics of each patterns and we derived 200 items that describe specific patterns of affect, cognition, motivation and behavior in childhood with a straightforward manner. Beyond the consideration of whether it is better not to label, avoiding stigmatization and leaving the development to have its course or rather is it higher risk to do so for traits that exist and could lead to a structured pathology without intervention, we would like to consider emerging personality patterns in childhood as developmental trajectories that can be examined. We believe that investigating the precursors and pathways of personality disorders during childhood, integrating developmental issues, biological vulnerabilities, and problematic environments, has the potential to define a longitudinal developmental approach to personality development and psychopathology. Our approach tries to address this challenge, conjugating both top-down (theoretical) and bottom-up (research) perspectives, based on research and clinical evidence (Fortunato & Speranza, in press). First Personality Organization is the Healthy Personality, the second one is the Neurotic Personality Organization that includes: Inhibited/Withdrawn Emerging Personality Pattern, Pathological Obsessiveness Emerging Personality Pattern and Dysphoric Emerging Personality Pattern. The third one is the Borderline Personality organization that includes: Dysregulated Emerging Personality Pattern and Pathological Narcissism Emerging Personality Pattern. The last one is the Psychotic Personality Organization that includes: Suspicious Emerging Personality Pattern and Schizoid emerging personality pattern. Items and Patterns were tested through theoretical and statistical consensus. The theoretical consensus was obtained by 30 expert clinicians that evaluated on a 5-point Likert scale each Pattern and item. The statistical consensus involved 42 clinicians assessing 42 children (M=7.92; 64% male). Afterwards, we started with the validation procedure. One hundred clinicians evaluated 100 children (M=8,7; 74% male), from 5 to 11 years old, in treatment from 2 to 12 months. Procedure includes other instruments: CPNI (Coolidge, 2002), CBCL (Achenbach, 2001) e PDC-C (Malberg, Rosenberg, Malone, 2017). Results: Theoretical consensus: clinicians rated 4 or 5 to all the Patterns and most of the items, only few items were rated 3. Statistical consensus: we evaluated the mean score and the standard deviation (SD) for each item. Only 16 out of 200 items reached a SD lower than 1.50 and a little mean score. Then, to evaluate the internal coherence of each Pattern, we measured the Cronbach’s alpha that reached really good or excellent levels for each Emerging Patterns. According to the consensus results, we modified the problematic items to obtain the final version of the instrument. For the validation procedure we conducted the Q-Factor analysis to obtain Emerging Personality Patterns empirically derived. Then we evaluated the correlation between the Q-Factor’s and the other instruments. Validation procedure highlights the Q-Sort’s validity to evaluate childhood personality. Conclusions: Using the literature and research data, this study defined possible developmental pathways for emerging personality patterns in childhood. We consider that it is possible to define emerging patterns that may lead to personality disorders in adolescence and adulthood. The study of childhood personality can inform us about mental functioning, precursors and pathways of development. Preliminary data is promising and seems to confirm that the personality can be investigated during childhood. The Q-Sort procedure is the best way to assess childhood personality and its elements.